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PSYCHOSOCIAL IMPLICATIONS OF DIABETES MELLITUS ON DIABETIC PATENTS

Psychosocial Implications of Diabetes Mellitus on Diabetic Patents

CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY.

Globally, as of 2010 an estimated 285 million people had diabetes, with type 2 making of about 90% of the cases (Willian textbook of Endocrinology) (12th ed). Its incidence is increasing rapidly and by 2030, the number is estimated to almost double.        Diabetes mellitus is classified in to four broad categories which, includes type 1, type 2, Gestational, and other specific types. The term “diabetes” without qualification usually called diabetes mellitus. The uncommon disease diabetes insipidus has related symptoms as diabetes mellitus but without disturbance in the sugar metabolism (insipidus means “without taste” in Latin) (David, et al, 2011). The term” type1 diabetes” has replaced several former terms, they include Juvenile diabetes, childhood-onset diabetes, and (IDDM) insulin dependent diabetes mellitus. Similarly, the term “type 2 diabetes “ has been used in place of several former terms; obesity related diabetes, adult onset diabetes, and (NIDDM) non insulin dependent diabetes mellitus. The cause of diabetes mellitus is type dependent. The Type 1 diabetes is to some extent inherited and then triggered by certain infections, with some evidence pointing of coxsackie B4 virus. Type 2 diabetes is due to primarily lifestyle factors and genetics. Gestational diabetes is caused by pregnancy. (Riserus and willet, 2009). Glycated hemoglobin (HB A1C) ≥ 6.5% (W.H.O 2006).Insulin and some oral medications, can cause hypoglycemia (low blood sugar) when administered in over load, and this can be dangerous if severe. Both type 1 and type 2 are chronic conditions that cannot be cured. (Diabetes– overview, 2013).        Adequate treatment of diabetes mellitus is this important, as well as blood pressure control and life style factors such as stopping smoking and maintaining a health body weight, with good exercise and good diabetic diet.

1.1 STATEMENT OF PROBLEM

Despite the series of care, health education and medication given to patient with diabetes mellitus in Hospital, complications of this condition as observed by the researcher during her clinical experience is not encouraging. Some of these patients do not comply to their dietary regime, medication and exercise, but yet develop one problem or the other. The researcher therefore wants to study the psychosocial implication of diabetes mellitus on diabetic patient attending Federal Teaching Hospital Abakaliki.However, it is important that individuals who are at risk of having diabetes mellitus (e.g. obese and pregnant individuals) and those who are having it already, should be well informed and helped to achieve and maintain a good glycemic control through out their life. Intensive education, of these group of person’s will go a long way minimizing the risks, effects, and complications associated with diabetes mellitus, in essence, the American diabetes association (2008) state educational curricular specific to each type of diabetes encountered. The rates of complication of diabetes mellitus will definitely decrease when diabetes mellitus is managed appropriately, and the effects of this diabetes made known to the client.Un treated diabetes leads to many complications, Acute complications such as ketotic acidosis and non- ketotic hyperosmolar coma. Serious long term complications, includes, diabetic retinopathy, chronic renal failure, as well as cardiovascular diseases and many others such as diabetic neuropathies which is the major cause of diabetic foot ulcers that can be difficult to treat and occasionally require amputation.However, the management of diabetes is usually accomplished with diet, exercise, and the use of appropriate medication.All forms of diabetes have been treatable since insulin became obtainable in 1921, type 2 diabetes can be controlled by medications  Diabetes mellitus is characterized by frequent hyperglycemia, it is diagnosed by demonstrating any of these (World health Organization, 2006), fasting plasma glucose level ≥7.0- mm01/1 (126mg/dl), plasma glucose ≥11.1mm01/1 (200mg/dl) 2 hours after 75 oral glucose load as in a glucose tolerance text. In a Nigeria based study carried out in Lagos Teaching hospital, it was discovered that the incidence of diabetes mellitus ranges from 0.25 to 2.5% of which was gestational, 60% type 11 and 10% type 1 diabetes mellitus (Ripoll, 2011). Also a 2010 study estimated that more than 92 million Chinese adults have the disease, while another 150 million are showing early symptoms. And it was stipulated by international diabetes foundation, that Indian has more diabetic than any other country in the world. (Galen and Jason 2010). Diabetes mellitus is the most common endocrine disorder and usually occurs when there is deficiency or absence of insulin activity (insulin resistance). The insulin deficiency in the circulatory system may likely result from a deficiency of islet- B-cells in the pancreases and the deficiency of islet- B- cells may result from the destruction of the islet of langarhans. (Dallas, 2011). Diabetes mellitus can be defined as a chronic progressive metabolic disease that occurs when the body cannot use or regulate glucose in the blood. It is characterized by polydipsia, polyphagia and polyuria. (David et al 2011).Diabetes mellitus is as old as man. Globally, there are different prevalent levels varying from country to country, face and ethic groups. The international diabetes federation in its recent publication came up with prevalence and incidence values around different regions and countries of the world. Diabetes mellitus occurs through out the world, but it is more common (especially type 2) in the more developed countries. However, there is an increasing rate of diabetes mellitus in developing countries (polisena et, al 2009). The greatest increase in prevalence is however expected to arise in both Asia and Africa, where most patients will most likely be seen by 2030 (Trank et al, 2009). The increase in incident in developing countries follows the trend of urbanization and life style change, perhaps most importantly a “western style” diet. This has suggested an environmental (I.e., dietary) effects, but there is little understanding of the mechanism (s) at present though there is much speculation some of it most compelling presented.

1.2 OBJECTIVES OF THE STUDY

  • To determine the knowledge of diabetic patient about diabetes mellitus.
  • To identify the method of managing of diabetes among the diabetic patient at Federal Teaching Hospital Abakaliki.
  • To determine the psychosocial implication of diabetic mellitus on diabetes patient attending Federal Teaching Hospital Abakaliki.

1.3 SIGNIFICANCE OF THE STUDY.

This study will enhance patients (diabetic individuals) and health workers knowledge on the cause / predisposing, management and psychosocial implication of diabetes.

This will help to reduce the incidence of diabetes in our society.

1.4 RESEACH QUESTIONS

  • What is the knowledge of diabetic patient about diabetes?
  • What are the best management methods for the diabetic patients?
  • What are the psychosocial implications of diabetes mellitus on diabetic patient attending Federal Teaching Hospital Abakaliki?

1.5 SCOPE OF THE STUDY AND LIMITATION

The study covers the psychosocial implication of diabetes mellitus on diabetic patient attending Federal Teaching Hospital Abakaliki form Jan- Dec 2014.

1.6 OPERATIONAL DEFINITION OF TERMS.

DIABETES MELLITUS: Is a clinical condition in which there is excessive amount of glucose in the blood and urine.

Psychosocial implication of diabetes on the diabetics: These are the pronounced outcome of diabetes mellitus which are usually detrimental to the health of the diabetics.

DIABETICS PATIENT: A diabetics patient, is any individual who is suffering from diabetes mellitus.

Knowledge of diabetes mellitus: this is the awareness of an individual about diabetes mellitus.

METHOD OF MANAGING DIABETES MELLITUS: This can be described as the ways through which that diabetes mellitus can be treated and cured which involves the uses of insulin, diet therapy and methods.

CHAPTER TWO

2.0 LITERATURE REVIEW

This chapter presents a review of available literature related to the study. The available literature were discussed according to the following subheadings.

conceptual review: Definition of Diabetes mellitus, classification of diabetes mellitus, pathophysiology, features/signs and symptoms of diabetes, Risk factors of diabetes mellitus, Diagnosis of diabetes mellitus, psychosocial implication of diabetes, management of diabetes mellitus, theoretical frame work related to the study, Empirical studies, summary of literature review.

2.1 DEFINITION OF DIABETES MELLITUS

Diabetes mellitus can be defined as a chronic metabolic condition that is characterized by chronic hyperglycemia and disturbance on carbohydrate, lipid and protein metabolism, giving rise to defect in insulin secretion and action (Andreoli et al., 2009). Further more, the world health organization, (WHO) (2006) defined it as a chronic disease which occurs when the pancreas does not produce enough insulin or when the body cannot effectively use insulin that it produces. As a result of this, there is increase level of glucose in the blood.

2.2 CLASSIFICATION OF DIABETES MELLITUS

A lot of authorities and researchers have tried to classify diabetes mellitus, each with his /her own criteria. Initially, diabetes mellitus was classified based on the patient age, at which the diagnosis was made. With this criteria, diabetes was described an being either “Juvenile onset or maturity onset”. This classification was later replaced by World Health organization classification in (2007) which recognized the main types of diabetes as follows:

Type 1 diabetes mellitus.

Type 2 diabetes mellitus.

Malnutrition related diabetes mellitus.

Impaired glucose tolerance.

Gestations diabetes mellitus.

Secondary to other diseases and conditions type.

However, in 2008 World Health Organization compressed the classifications into three main types and they are:

Type 1 diabetes mellitus.

Type 2 diabetes mellitus.

Gestational diabetes mellitus.

 TYPE 1 DIABETES MELLITUS.

Type 1 diabetes mellitus can also be called insulin dependent diabetes mellitus that present more commonly in children but can also occur at any age.

Insulin dependent diabetes mellitus is a heterogenous group of disorders with the deficiency of insulin in the circulatory system. This deficiency may be as a result of the destruction of islet B-cells that produces insulin.

In this form of diabetes mellitus, the deficiency of insulin is gradual. At the start of the disease, there could be traces in the circulatory system but as from 5-10 years, there is complete deficiency of insulin in the circulatory system of the patient.

In some cases is attributed to autoimmune process and as the name implies Insulin dependent diabetes mellitus (IDDM), its treatment depends on insulin administration.

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